Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Hernia. 2021 Aug;25(4):1035-1050. doi: 10.1007/s10029-020-02358-5. Epub 2021 Jan 19.
The use of mesh in ventral hernia repair becomes especially challenging when associated with a contaminated field. Permanent synthetic mesh use in this setting is currently debated and this discussion is yet to be resolved clinically or in the literature. We aim to systematically assess postoperative outcomes of non-absorbable synthetic mesh (NASM) used in ventral hernia repair in the setting of contamination.
A literature search of PubMed, Embase, Scopus, Cinahl, and Cochrane Library identified all articles from 2000-2020 that examined the use of NASM for ventral hernia repair in a contaminated field. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Qualitative analysis was completed for all included studies using a modified Newcastle-Ottawa scale.
Of 630 distinct publications and 104 requiring full review, this study included 17 articles published between 2007 and 2020. Meta-analysis demonstrated absorbable mesh was associated with more HR (OR 1.89, 1.15-3.12, p = 0.008), SSO (OR 1.43, 0.96-2.11, p = 0.087), SSI (OR 2.84, 1.85-4.35, p < 0.001), and unplanned reoperation (OR 1.99, 1.19-3.32, p = 0.009) compared to NASM.
The use of NASM for ventral hernia repair in a contaminated field may be a safe alternative to absorbable mesh, as evidenced by lower rates of postoperative complications. This review counters the current clinical paradigm, and additional prospective randomized controlled trials are warranted.
当与污染区域相关时，网片在腹疝修复中的使用变得极具挑战性。在这种情况下，永久性合成网片的使用目前存在争议，并且这一讨论尚未在临床或文献中得到解决。我们旨在系统评估在污染区域中使用不可吸收合成网片（NASM）进行腹疝修复的术后结果。
通过对 PubMed、Embase、Scopus、Cinahl 和 Cochrane Library 的文献检索，确定了所有 2000 年至 2020 年间检查在污染区域中使用 NASM 进行腹疝修复的文章。通过汇总分析和荟萃分析评估术后结果。使用改良的 Newcastle-Ottawa 量表对所有纳入的研究进行定性分析。
在 630 篇不同的出版物和 104 篇需要全文审查的出版物中，本研究纳入了 2007 年至 2020 年期间发表的 17 篇文章。荟萃分析表明，可吸收网片与更高的 HR（OR 1.89，1.15-3.12，p=0.008）、SSO（OR 1.43，0.96-2.11，p=0.087）、SSI（OR 2.84，1.85-4.35，p<0.001）和计划外再次手术（OR 1.99，1.19-3.32，p=0.009）相关。
在污染区域中使用 NASM 进行腹疝修复可能是可吸收网片的安全替代方案，这一点可以从较低的术后并发症发生率得到证明。本综述反驳了当前的临床范例，需要进行更多的前瞻性随机对照试验。
